Community Service Survey

Instructions:

Please take a few moments to complete an information form for each student that you employ.

Please provide this information for all work-study students who have worked for you this fiscal year, even if they are no longer employed by your department.

Keep in mind that being an employee of the University of Utah does not automatically classify a student’s work as community service. Although the University as a whole is heavily involved with the community, please consider the specific activities of your department and the work-study student’s role within the department when completing the Community Service Information Form.

* Indicates a required field.

Federal Work-Study (FWS) Community Service Information
  1. (5 digit #)
Preparer (Supervisor or Payroll Reporter)
Student Information
  1. (8 digit # - no 'u')
  2. ($xx.xx) per hour
  3. *Do you consider your agency to be community service?:
  4. (up to 3 digit #)
Please answer the following questions
  1. *The services of the agency are available to the entire community:
  2. *The agency has a system in place to track what percentage of its services are utilized by the non-university
    community:
  3. *The agency is affiliated with non-profit, governmental, or community-based agencies:
  4. *Advertising is directed to the whole community:
  5. *The service targets low-income families:
  6. *The service targets the hearing/sight/physically impaired:
 
Last Updated: 9/12/13